Recours aux soins et utilisation des services de santé à Nouakchott (Mauritanie): inégalités spatiales ou pesanteurs sociales?

In African cities where environmental, social and economic problems facilitate the development of urban pathology, inadequate or ineffective health facilities raise the question of access to quality care, especially for slum dwellers. The city of Nouakchott marked by a multifaceted urban crisis is an illustration of this troubling situation. To analyse the spatial organisation and functioning of the healthcare system by assessing the use of health services, we studied this utilisation in August 2004 in three areas of the city by a cross-sectional survey of 836 households. The results show that therapeutic itineraries are as diverse as health care provision is varied. About 50.8 % of those seeking health care reported using modern services (public health clinics, private clinics, private doctors or nurses) for the most common diseases (acute respiratory infection and diarrhea) in their community, but this rate varied significantly by disease, social category and neighborhood. Thus, this mediocre level of utilisation of public health clinics is due to the poor quality of care provided. Moreover, healthcare services are often used only in case of severe or worsening illness, with signs (e.g., cough and persistent fever, or weight loss) seen to suggest more serious diseases, such as tuberculosis, meningitis or severe malaria. Geographic accessibility of health services was relatively good (70 %). It was the economic, socio-cultural, organizational and functional factors that appeared to determine the choice to use modern health care. The slackening of socio-cultural and organizational constraints and adaptation to economic ones should help to improve health policies and foster a functioning healthcare system